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Biomedical subjects

Garry Walter

Publications and source records attributed to Garry Walter.

27 records · Page 2Linked to original sources
PubMed2003

Has the practice and outcome of ECT in adolescents changed? findings from a whole-population study.

OBJECTIVE: To investigate whether there were changes in the practice and outcome of electroconvulsive therapy (ECT) in adolescents in a whole population over a decade. METHOD: All persons younger than 19 years who received ECT in the state of New South Wales, Australia, in the period from 1990 to 1999 were identified. Detailed information about diagnosis, treatment and outcome were then obtained. RESULTS: Seventy-two patients aged 14-18 years underwent a total of 84 courses of ECT (1.53/100,000 adolescents were treated with ECT per year). In 1996 to 1999 compared with 1990 to 1995, there was an increase in ECT among females hospitalized involuntarily, EEG monitoring, stimulus dosing, bilateral ECT, and use of thiopentone. Overall, mood disorders derived most benefit from ECT while comorbid personality disorder predicted poorer short term outcome. Side effects were minor and transient. CONCLUSIONS: The changes in ECT practice are consistent with changes in ECT practice generally over the survey period. The overall data on effectiveness and safety further support the treatment's use in young people.

Adolescent↗
PubMed2003

How fixed are child psychiatrists' views about ECT in the young?

The experience, knowledge, and attitudes of Australian and New Zealand child psychiatrists in relation to ECT in the young were surveyed in 2000 to ascertain whether their views had changed since a similar survey was conducted in 1996. Fifty-four percent (n = 129) of the original sample answered a mailed questionnaire. Psychiatrists in 2000 had greater self-rated level of knowledge on the subject and were less likely to base that knowledge on adult ECT data. Psychiatrists in 2000 were also more likely than in 1996 to approve the use of ECT in adolescents. The finding that the views of child psychiatrists can change is reassuring, given emerging data showing ECT in young persons to be an effective and safe treatment, and the requirement in various countries that child psychiatrists participate in the decision to administer the treatment. It is possible that a number of publications and presentations on the topic after the first survey contributed to the change in views. Nevertheless, there remain gaps in child psychiatrists' knowledge about ECT in the young that need to be addressed. The study findings should not be over interpreted because of the reduced response rate in the follow-up survey.

Adolescent↗
PubMed2002

Experience, knowledge and attitudes of mental health staff regarding clients with a borderline personality disorder.

A survey of mental health staff experience, knowledge and attitudes regarding the management of clients with a diagnosis of borderline personality disorder (BPD) aimed to obtain baseline data to provide direction for developing planned education and determining staff willingness to participate in such training. A 23-item questionnaire was developed and posted to mental health staff in a public Area Mental Health Service in New South Wales (n = 516). A total of 229 staff completed the questionnaire. Most staff (85%) reported having contact with clients who have a diagnosis of BPD at least once a month or more frequently, with 32% of respondents reporting daily contact. Eighty per cent of respondents found dealing with clients who have a BPD to be moderate to very difficult; 84% of staff felt that dealing with this client group was more difficult than dealing with other client groups. Most staff (82%) believed that, as mental health professionals, they had a role in the assessment, management and referral of clients with BPD, as well as in educating and providing information. Staff readily identified resources which would be helpful to them when working with such clients. It was encouraging to see that the majority of staff (95%) indicated their willingness to gain further education and training in the management of these clients. Although many staff believed they were knowledgeable about and confident in managing these clients, most staff also indicated difficulties posed by these clients and perceived a need for further education and training in this area.

Adult↗
PubMed2002

Changes in the rate of diagnosis of major depression in adolescents following routine use of a depression rating scale.

OBJECTIVE: Because major depression in adolescents often goes undiagnosed, it is useful to establish whether clinicians' rates of making this diagnosis in a specialist adolescent mental health service change when a self-rating depression scale is routinely administered. METHOD: A retrospective, naturalistic study examining the rate of diagnosis of major depression in a mental health service between 1993 and 1997. The intervention was the administration of the Center for Epidemiological Studies Depression Scale (CES-D)prior to initial assessment from September 1995 onwards. The proportion of clinical diagnoses of DSM-III-R or DSM-IV major depression was the outcome measure. Age, gender, ratings of depression and other confounding variables were used to control for changes in patient population over time. RESULTS: One thousand three hundred and ten adolescents aged 12 to 17 years assessed between 1993 and 1997 were included. After taking into account potential confounders, diagnosis of major depression was 2.8 times (95% confidence interval 1.8, 4.3) as likely when the CES-D was in use. Increase was more marked when adolescents were more disturbed overall. There was no evidence suggesting this was due to changes in diagnostic practices or in the patient population. CONCLUSION: Availability to clinicians of a self-rating depression scale completed prior to assessment was associated with an increase in the frequency of diagnosis of depression in a specialist mental health service for adolescents.

Adolescent↗
PubMed2002

Medical student knowledge and attitudes regarding ECT prior to and after viewing ECT scenes from movies.

We surveyed samples of medical students in the United Kingdom (U.K.) and Australia, prior to their psychiatry placement, to ascertain views about electroconvulsive therapy (ECT) and the effect on those views of watching ECT scenes in movies. A 26-item questionnaire was constructed by the authors and administered to the students. At set times during the questionnaire, students were asked to view five movie clips showing, or making reference to, ECT. The clips were from Return to Oz, The Hudsucker Proxy, Ordinary People, One Flew Over the Cuckoo's Nest, and Beverly Hillbillies. Ninety-four students participated in the study. Levels of knowledge about the indications, side effects, and mode of administration were poor, and attitudes were generally negative. Viewing the ECT scenes influenced attitudes toward the treatment; after viewing, one-third of the students decreased their support for ECT, and the proportion of students who would dissuade a family member or friend from having ECT rose from less than 10% to almost 25%.

Adult↗
PubMed2002

ECT in poetry.

We sought to identify poems about Electroconvulsive therapy (ECT) and describe their major themes, with a view to using some of those poems in clinical situations-for persons receiving ECT and their families-as well as for teaching purposes. Several poems were identified, eight almost exclusively about ECT and a number of other works containing references to the treatment. The poets, some of whom have won distinguished prizes, came from the United States, U.K., Australia, and Estonia. The poems included very positive accounts of ECT and more denigrating pieces. Some of the themes covered by the poems were the desperate plight of persons prior to ECT, the potentially striking beneficial effects of the treatment, fears about the use of electricity, ECT procedure, and memory impairment, and the stigma associated with the treatment.

Attitude↗